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With new health insurance marketplaces making their debut next month, ministry leaders said they are gearing up to support outreach and enrollment efforts. They will educate the uninsured and underinsured about the new insurance options that soon will be available to them and help expand the number of people in their communities with meaningful, affordable coverage.w

"We need to plow ahead and get people covered. We're leaving no stone unturned" in trying to locate and enroll eligible people, said Mary Ella Payne, senior vice president of policy and system legislative leadership for St. Louis-based Ascension Health.

New offerings
Payne and other ministry leaders who spoke to Catholic Health World saidinformation has been coming out gradually from state and federal government agencies regarding the marketplaces — also called health exchanges — that the states and federal government are setting up. The marketplaces enable insurers to market qualified insurance offerings to individuals and small businesses. People can begin enrolling in coverage through the exchanges Oct. 1, and new health insurance policies will become effective in January.

Health care providers are working to understand the details so that their staffs in turn can educate people in the community.

Since "this is a new way to think about accessing insurance," educational efforts are needed, said Colleen Scanlon, senior vice president of advocacy for Englewood, Colo.-based Catholic Health Initiatives.

Catholic health care providers see the health exchanges as a key way to expand coverage in their communities. Through the exchanges, uninsured individuals, families and small businesses will be able to shop for coverage and determine their eligibility for government subsidies to help cover the cost of premiums.

Enrollment push
Providers including Ascension Health; Bon Secours Health System of Marriottsville, Md.; CHI and Providence Health & Services of Renton, Wash., are partnering with Enroll America to point uninsured people in their communities toward the coverage that is best for them, whether through the exchanges or other offerings, including Medicaid. CHA and Ascension Health are founding members of Enroll America, a broad-based coalition of health care and consumer groups that is educating people about the coverage they can attain and helping eligible people to sign up.

The ministry executives who spoke to Catholic Health World said their systems are preparing financial counselors to educate patients about the exchanges and enrollment resources. For instance, Ascension Health holds weekly calls with leaders of its facilities on emerging details so they can disseminate the information to their financial counselors.

Ascension Health efforts include educating clinicians on the Affordable Care Act and newly available insurance, so they can have the information they need to help their patients. Some Ascension Health facilities are promoting insurance enrollment at health fairs such as at screening events for uninsured people; preparing translators with information so they can conduct outreach in the community; and preparing to enroll people via iPads.

Sisters of Charity Health System in Cleveland plans to use social media and other channels to educate people about insurance options and eligibility.

CHI has formed a committee to determine how to educate community members in its facilities' service areas about their options and about how to sign up for insurance.

Navigators
Payne said Ascension Health also is exploring opportunities to enroll people under presumptive eligibility rules in the Affordable Care Act. For the first time, she said, the government is allowing hospitals to certify that people are eligible for Medicaid and to provide them with services under Medicaid coverage, until the government can process their application.

Payne said Ascension Health facilities — either on their own or as part of local coalitions — have applied for federal grants to become navigators. As established by the Affordable Care Act, navigators are trained and certified guides who help people enroll for Medicaid or for coverage through the marketplaces.

Working out the details
The health care leaders who spoke with Catholic Health World said health care providers are facing some challenges as they prepare to educate patients on new insurance options, and as they support enrollment efforts.

Janice Burnett, chief financial officer of Bon Secours, explained that the way that health exchanges are implemented state-by-state actually may have a significant impact on operations. Burnett said in some states, privately managed care insurance companies are the main providers of products in the health exchanges, or marketplaces, that will be available. Those companies are positioning themselves to drive patient choice. In some cases, Burnett said, the insurers are establishing exclusive, narrow network contracts with select health care systems and shutting out others.

This situation raises complex questions for a not-for-profit provider like Bon Secours, said Burnett. For instance, in Virginia, a managed care company that will offer a product or products on the exchange has a narrow network contract with another provider. Bon Secours will be out-of-network for people insured through that health exchange product. Bon Secours is determining how this will impact operations.

Bon Secours is assessing how to assist people with obtaining insurance through the exchanges when the product excludes Bon Secours as a provider. It addition, Bon Secours is reworking its financial assistance policies to address people who choose not to be insured, or who opt into high-deductible plans and cannot pay the deductible, or who lose their in-network status after buying insurance through the exchange.

Teresa Spalding is vice president of revenue cycle for Providence. She said in examining the new options coming into the marketplace, Providence is recognizing that people likely will be confused about what is available to them, and so Providence is preparing to be able to answer their questions. The system is doing this in part by educating the facility-level financial counselors who interact with patients without adequate insurance coverage.

Spalding said the Catholic health ministry has been looking for ways to help vulnerable people attain the care and coverage they need, and that will continue. "We have been very proactive for years in working with this population (of underinsured and uninsured people). We've been partnering and looking at every option," and that will continue as new options come on line, she said.